Active NPI
Michael John Jackson, MPT, B.ED.
- Physical Therapist
- Los Alamitos, CA
National Provider Identifier
1710126560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 35367
- Practice address
- 4226 Katella Ave
Los Alamitos, CA 90720-3511 - Phone
- (562) 431-6004
- NPI assigned
- Feb 17, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 35367 | CA | Primary |
Addresses
Primary practice location
4226 Katella Ave
Los Alamitos, CA 90720-3511
Mailing address
7890 E Spring St
# 11-I
Long Beach, CA 90815-1636
Phone (714) 656-7576
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35367 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Einhorn Mandas & Bradley Rehab Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Los Alamitos, CA
- NPI 1629094420
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234828800000",
"number": "1710126560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7890 E SPRING ST",
"address_2": "# 11-I",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908151636",
"telephone_number": "714-656-7576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4226 KATELLA AVE",
"city": "LOS ALAMITOS",
"state": "CA",
"postal_code": "907203511",
"telephone_number": "562-431-6004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHAEL",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "MPT, B.ED.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-17",
"last_updated": "2009-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "35367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Alamitos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.